title: Modeling seizure self-prediction: an e-diary study.
abstract: OBJECTIVE
  A subset of patients with epilepsy successfully self-predicted seizures in a paper diary study. We conducted an e-diary study to ensure that prediction precedes seizures, and to characterize the prodromal features and time windows that underlie self-prediction.
  
  
  METHODS
  Subjects 18 or older with localization-related epilepsy (LRE) and ≥3 seizures per month maintained an e-diary, reporting a.m./p.m. data daily, including mood, premonitory symptoms, and all seizures. Self-prediction was rated by, "How likely are you to experience a seizure (time frame)?" Five choices ranged from almost certain (>95% chance) to very unlikely. Relative odds of seizure (odds ratio, OR) within time frames was examined using Poisson models with log normal random effects to adjust for multiple observations.
  
  
  RESULTS
  Nineteen subjects reported 244 eligible seizures. OR for prediction choices within 6 h was as high as 9.31 (CI 1.92-45.23) for "almost certain." Prediction was most robust within 6 h of diary entry, and remained significant up to 12 h. For nine best predictors, average sensitivity was 50%. Older age contributed to successful self-prediction, and self-prediction appeared to be driven by mood and premonitory symptoms. In multivariate modeling of seizure occurrence, self-prediction (2.84; CI 1.68-4.81), favorable change in mood (0.82; CI 0.67-0.99), and number of premonitory symptoms (1.11; CI 1.00-1.24) were significant.
  
  
  CONCLUSIONS
  Some persons with epilepsy can self-predict seizures. In these individuals, the odds of a seizure following a positive prediction are high. Predictions were robust, not attributable to recall bias, and were related to self-awareness of mood and premonitory features. The 6-h prediction window is suitable for the development of preemptive therapy.
authors.affiliation: Montefiore-Einstein Epilepsy Center, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, U.S.A; Department of Neurology, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, U.S.A.
authors.forename: Sheryl R
authors.initials: SR
authors.lastname: Haut
authors.forename: Charles B
authors.initials: CB
authors.lastname: Hall
authors.forename: Thomas
authors.initials: T
authors.lastname: Borkowski
authors.forename: Howard
authors.initials: H
authors.lastname: Tennen
authors.forename: Richard B
authors.initials: RB
authors.lastname: Lipton
mesh_terms: D000293:Adolescent; D000328:Adult; D000339:Affect / Q000502:physiology*; D002648:Child; D059026:Diagnostic Self Evaluation; D004569:Electroencephalography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D016017:Odds Ratio; D012640:Seizures / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology*; D013997:Time Factors; D055815:Young Adult
keywords: Electronic diary; Localization-related epilepsy; Premonitory symptoms; Seizure diary; Seizure precipitants; Seizure prediction; Self-prediction